Accessory Hepatic Vein Recanalization: A Viable Approach in Hepatic Vein Outflow Tract Obstruction.

Objective: To evaluate the mid and long term outcome of recanalization of accessory hepatic vein secondary to hepatic venous outflow obstruction and to compare the mid and long term outcome and technical efficacy and safety of accessory hepatic vein recanalization with native hepatic vein recanalization in HVOTO patients.

Methods: This retrospective observational study, conducted at a single centre, evaluated the mid- and long-term outcomes of AHV recanalization compared to native HV recanalization in 170 HVOTO patients treated between January 2013 and October 2020.

Results: Patients were divided into two groups based on the type of recanalization performed: AHV (n = 26) and native HV (n = 144). Technical success was achieved in 100% of AHV cases and 95.8% of native HV cases. The primary patency rates at 1, 3, and 5 years were 95.9%, 92.3%, and 76.9% for AHV and 96.5%, 93%, and 79.1% for native HV, respectively. Significant improvements in liver stiffness, clinical symptoms, and hepatic function were observed post-intervention in both groups, with no significant differences in outcomes. Transplant-free survival rates at 1, 3, and 5 years were also comparable between groups.

Conclusion: This study demonstrates that AHV recanalization is a safe and effective alternative to native HV recanalization, providing comparable long-term outcomes.

Advances in knowledge: It offers a promising option for HVOTO patients with dominant AHV and extensive intrahepatic collaterals, further supporting its integration into the stepwise management of HVOTO.